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Physical activity practice and sports preferences in a group of Spanish schoolchildren depending on sex and parental care: A gender perspective

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Physical activity plays an important role in the maintenance of health, and it is especially important during childhood. However, the lack of information about differences in physical activity practice and sports preferences of children considering gender differences can result in non-effective policies that enhance inequalities between sexes.

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R E S E A R C H A R T I C L E Open Access

Physical activity practice and sports

preferences in a group of Spanish

schoolchildren depending on sex and

parental care: a gender perspective

África Peral-Suárez1* , Esther Cuadrado-Soto1, José Miguel Perea2,3, Beatriz Navia1,3, Ana M López-Sobaler1,3and Rosa M Ortega1,3

Abstract

Background: Physical activity plays an important role in the maintenance of health, and it is especially important during childhood However, the lack of information about differences in physical activity practice and sports

preferences of children considering gender differences can result in non-effective policies that enhance inequalities between sexes The aim of this study is to identify the sports preferences of Spanish schoolchildren and their physical activity practice behaviors depending on their sex and their parental care, analyzing the possible

differences from a gender perspective

Method: Three hundred sixty-four Spanish schoolchildren (179 girls, 185 boys) participated in this cross-sectional study A daily physical activity questionnaire was used to evaluate physical activity level (PAL), moderate-to-vigorous physical activity (MVPA) and sports preferences and a socio-health questionnaire were used to collect data about parental care Statistical analysis was performed using SPSS and applying Student’s T-test for normal variables, Mann-Whitney U-test for non-parametrical variables, and chi-square (χ2) test for categorical variables Subsequently, odds ratios were used to analyze associations between the physical activity practice of the children and parental care

Results: PAL and time spent in MVPA was significantly lower for girls compared to boys (1.44 ± 0.07 vs 1.46 ± 0.07,

p < 0.001 and 0.74 ± 0.40 h/day vs 0.90 ± 0.45 h/day; p < 0.001, respectively) Dancing, rhythmic gymnastics, skating, and water sports were practiced more by girls, while football, wrestling sports, handball, and racket sports were practiced more by boys (p < 0.05) Children cared for by their fathers had higher odds for physical activity practice (OR = 1.995 (1.202–3.310), p = 0.008)

Conclusion: Physical activity among girls was less frequent and less intense Girls opted for individual sports with artistic connotations, while boys often practiced more team contact sports Furthermore, children are more

physically actives when their father is in charge of them

Keywords: Physical activity, Sport preferences, Schoolchildren, Sex differences, Gender, Parental influence

© The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the

* Correspondence: africper@ucm.es

1 Department of Nutrition and Food Science, Faculty of Pharmacy at

Universidad Complutense de Madrid, Madrid, Spain

Full list of author information is available at the end of the article

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Regular physical activity has numerous benefits for both

physical and mental health, including the prevention of

be-ing overweight or obese, and the risk of chronic diseases

(cardiovascular, diabetes, cancer, etc.), as well as reduced

levels of stress and anxiety, impacting on psychological

wellbeing and quality of life [1,2] Furthermore, in the case

of schoolchildren, physical activity has been positively

asso-ciated with academic performance [3] Physical inactivity is

related to greater risk of diseases and various physiological

and psychological problems, being identified as the fourth

highest risk factor for mortality worldwide [1,4]

In this context, physical activity and sports practice

tend to be different between boys and girls, being lower

in the case of girls, both in terms of frequency and

in-tensity, independent of their level of education [5,6]

Among possible barriers that girls face when engaging

in physical activity and sports are the gender stereotypes

associated with physical activity due to the masculine

image it projects This can lead to a refusal to participate

in“male sports” for parts of the female population [7,8]

Increased difficulty achieving required goals generates

huge pressure for females [9] These gender roles are

as-sumed from an early age [7]

The results from various past studies show that girls tend

to prefer activities related to body shape and health with a

more aesthetic orientation, preferring individual sports,

while boys tend to opt for activities focused on improving

fitness or physical performance, choosing team sports in

which strength and competitiveness predominate [10,11]

Several studies have shown that practice of physical

activ-ity by parents or parental support in this area may improve

physical activity by the children However, the difference

between maternal and paternal influence is not clear In

some studies, it was observed that both figures have equal

influence While in others, it was indicated that the figure

that shares the sex of the schoolchild has more influence,

or that the paternal figure is the most influential [12–15]

Most research on the practice of physical activity by

schoolchildren focuses on time or on active

transporta-tion, ignoring the preferences of children for particular

sports or types of activity Researching these factors

could improve our understanding of the reasons why

they enjoy said preferences [16]

The aim of this study was to determine the differences

in sports preferences of schoolchildren, as well as their

practice of physical activity depending on their sex, in

addition to investigating the influence children’s parents

or guardians in their activeness We analyze all these

factors from a gender perspective

Materials and methods

The study design and methodology have been previously

described [17–19] The study was conducted in

accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee for Clinic Review of the Clinic San Carlos Hospital, which is part of the Universidad Complutense de Madrid (Madrid, Spain) (Ref 12/319-E and 15/522-E) The trial was registered at clinicaltrials.gov as NCT03465657

In brief, a cross-sectional observational study was car-ried out between February 2014 and February 2018 in

11 randomly contacted schools from different Spanish provinces, with representation from urban and semi-urban areas, in which 367 participated healthy children aged between 7 and 11 years The obtaining of the sam-ple and methodology used to collect the different data is deeply described below

Subjects

Participation in this study was offered to twenty-six randomly-contacted primary schools Eleven schools from six different Spanish provinces (Madrid, Zaragoza, Segovia, Córdoba, Ciudad Real and Tenerife) took part

in the project, of which five were in the capitals of the provinces involved and six in a semi-urban area (less than 50,000 inhabitants) Of the 1806 children who were contacted to participate, a sample of 367 children was recruited to the trial, (182 girls, 185 boys) (Fig.1) Each school was contacted by telephone Once the schools Directors had accepted the invitation to participate, parents

of children aged between 7 and 11 years received a letter explaining the study in detail and were given an informed consent form to fill out, as to whether they agreed with the participation of their child Afterwards, a member of the re-search group met the parents who accepted the participation

of their children in the study at their child’s schools This was to discuss any doubt about the trial and collect the signed informed consent forms In said initial meeting, the member of the research group provides parents with the questionnaires to complete Five days after the meeting, the researchers went to the school to carry out the anthropomet-ric measurements and collect completed questionnaires The exclusion criteria were: a lack of signed informed consent, having an illness or physical impairment that could alter the results (serious infection or metabolic or chronic diseases as diabetes mellitus, hepatic or kidney disease), having have had surgery in the 6 months prior

to the study and lack of completed questionnaires Children whose questionnaires had missing answers for isolated questions were excluded from the analysis of those particular questions but not from the whole study

Anthropometric and Sociodemographic data

All anthropometric measurements were taken in the morning and in accordance with the WHO criteria [20], namely the children being barefoot and wearing just their underwear The children entered in small groups

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of approximately 5 children into the room where the

measurements were being taken and were measured one

by one in a space separated from the rest of the room by

folding screens by two researchers One of the

re-searchers was in charge of taking the measurements and

the other was in charge of noting the results

Data about weight and height were determined using a

digital electronic scale (range 0.1–150 kg; precision 100

g; Alpha; Seca, Igni, France) and a digital stadiometer

(70–205 cm; 1 mm; Harpenden Pfifter, Carlstadt, NJ,

USA) respectively The body mass index (BMI) was

cal-culated from these measures

Weight status was determined using BMI specific

per-centiles for age and sex in the reference population

fol-lowing the criteria stablished by the International

Obesity Task Force (IOTF) [21]

Waist circumference was measured using a flexible

metallic tape (range 0–150 cm; precision 1 mm; Holtain,

Crymych, Wales) The measurement was taken midway

between the inferior margin of the last rib and the crest

of the ileum, in the horizontal plane

To obtain the sociodemographic data, we used a

ques-tionnaire about their social, economic, and health status

[see Additional File 1], which were completed by their

parents This questionnaire included data on the

chil-dren’s caregivers, including the academic level of their

parents and the household incomes

Physical activity data

An adapted physical activity daily questionnaire [22] [see

Additional File 2], which has been previously used in

other studies [23–25], was filled out by the parents about their children Questions find the time spent dur-ing weekdays and weekends in different kind of physical activities (including active play and extracurricular sport classes, physical education and daily life activities) and sedentary behaviors (including watching TV, playing videogames, tablet or computer use) Furthermore, ques-tions were included about the kinds of sports practiced during extracurricular sporting classes, including the number of days per week and the time per session dedi-cated to each extracurricular sport class

After collecting the information, individual physical activity levels (PAL) were calculated by multiplying the time in hours spent on each group of activities with their assigned coefficient depending on their intensity (1.0 for rest, 1.5 for very low-intensity PA, 2.5 for low-intensity

PA, 5.0 for moderate-intensity PA and 7.0 for very high-intensity PA) following the WHO criteria [26] Addition-ally, the reported mean of moderate to vigorous physical activity (MVPA) hours per day was quantified, consider-ing those activities with the assigned factors 5 or 7 [26], which included: physical education in school and extra-curricular physical activities The reported mean of sedentary leisure hours per week was computed, consid-ering the use of electronic displays (computer, video-game console, tablet, and TV) This data was used to estimate adherence to the recommendations of physical activity (≥60 min MVPA per day) and screen time (≤2 h per day) contained in the guidelines [27,28]

We also classified children as non-sedentary when their PAL was 1.4 or higher [29]

Fig 1 Obtaining the sample

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Statistical analysis

All the results were analyzed using the IBM SPSS Inc

statistical software (version 25.0) and they were shown

as mean ± standard deviation (SD), medians, and

inter-quartile range (IQR) or as proportions if variables were

categorical The Kolmogorov–Smirnov test was used to

assess the normality of the variables To compare data

between sexes, we used the Student’s two sample t-test

(in cases of normal variables), Mann–Whitney U-test (in

cases of non-parametrical variables), andχ2 test for

cat-egorical variables

Subsequently, logistic regression models were used to

analyze the possible association between physical activity

of the children (dependent variable) and the person who

takes care of them (independent variables), using as

ref-erence for physical activity practice: PAL≥1.4, according

to National Academy of Medicine (NAM) cut-off points,

previously known as Institute of Medicine (IOM) [29]

This association was evaluated by 3 models of the odds

ratio (OR) using 95% confidence intervals (CI): (a) a

basic model without any adjustment, (b) a second model

taking into account sex and age, and (c) a third model

including model b plus the rest of the predictor

vari-ables: cared by mother (yes/no), cared by father (yes/no)

or cared by others (yes/no)

Differences were considered statistically significant if

thep-value < 0.05

Results

From the initial sample of 367 children (182 girls and

185 boys), three girls did not answer at least one of the

questionnaires, so the final sample was reduced to 364

children (179 girls and 185 boys)

The mean age of the participants was 8.98 ± 1.21 years

No significant differences between sexes were found

analyzing anthropometric measures and

sociodemo-graphic data collected in Table1

Physical activity and sedentary behavior according to sex

The results of Table 2 show that boys performed more

(p < 0.001) and more intense (p < 0.001) physical activity

than girls, spending more time on attending extracurricular

sport classes (p = 0.001) and on active playing (p = 0.014)

Furthermore, adherence to physical activity guidelines

is also significantly higher in case of boys (42.0% vs

23.46%;p < 0.001) However, males also spent more time

using electronic displays such as PCs, tablets or

video-game consoles (1.01 ± 0.78 h/day vs 0.76 ± 0.58 h/day;

p < 0.001)

Even though no significant differences among sexes

were found related to adherence to sedentary guidelines,

it is important to highlight that adherence to sedentary

behavior recommendation was low (41.95%), with more

than a half of the study population being sedentary

Furthermore, the percentage of the sample that adheres

to physical activity guidelines is also below the half (32.7%), being lower the adherence of girls respect to boys (p < 0.001)

Sports preferences by sex

Figure 2 shows that the most practiced sport was foot-ball (n = 89), followed by dancing (n = 68), water sports (n = 57), and basketball (n = 45) By contrast, the less practiced sports were golf, volleyball, and climbing (n = 2), followed by yoga (n = 4) Comparing preferences by sex, the results showed that girls were more inclined to choose dancing (p < 0.001), rhythm gymnastics (p < 0.001), skating (p = 0.005), and water sports (p = 0.012), while the boys opted for football (p < 0.001), wrestling sports (p < 0.001), racket sports (p = 0.004), and handball (p = 0.020) For the rest of sports, no significant differ-ences were found among sexes

The percentage of non-sedentary boys (PAL≥1.4) was higher than the percentage of non-sedentary girls (82.9%

vs 68.2%;p = 0.001)

Table 3 shows the association between active children (PAL≥1.4) and the sex of the caregiver Children cared

by their father were more likely to engage in physical ac-tivity (OR = 1.995 (1.202–3.310), p = 0.008), which was not seen in those cared by their mother After adjusting for age, sex, and the rest of the predictor variables, this association was also observed in children cared by a per-son different from the father or the mother (OR = 2.222 (1.136–4.343), p = 0.020) However, it was not known if this person was a male or female figure

Discussion

28.02% of the total sample presented overweight and the 10.16% were obese, without significant differences among sexes The percentage of overweight is higher than that in other studies carried out in the Spanish population, such as the ALADINO study, where in a sample of 10,899 children aged between 6 and 9 years, the percentage of overweight and obesity using the IOTF cut-off points was 21.8 and 11.2%, respectively [30] This may be due to the prepubertal adipose rebound previ-ously described by other authors [31,32], as our sample includes children up to 11 years old

In our results, a higher and more intense physical ac-tivity practice by boys than by girls was appreciable, be-ing higher their PAL (1.46 ± 0.07 vs 1.44 ± 0.07;

p < 0.001) the time spent in MVPA (0.90 ± 0.45 h/day vs 0.74 ± 0.40 h/day; p < 0.001) (Table 2) and their adher-ence to physical activity recommendations (42.0% vs 23.46%; p = 0.000),as it occurred in other studies with schoolchildren population, such as the ANIBES study in Spain [33], the Youth Study in China [34] or the study

of Williamson et al performed in England and Scotland

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Table 1 Anthropometric and sociodemographic data of the study sample according to sex

Girls (n = 179) Boys (n = 185) Total (n = 364) Anthropometric data

Weight status

Sociodemographic data

SD Standard deviation; BMI Body mass index; VT Vocational Training †: p-value calculated by Mann–Whitney U-test

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[35] A possible explanation to this situation is that

dur-ing school breaks or after-school day care, boys usually

take advantage of this time to practice sports, while girls

use this time in sedentary activities focused on

socialization [36–38] This is reflected, too, in the

differ-ences found among sexes when time dedicated to active

play was analyzed, as boys spent more time on active

play than girls (p = 0.014), which is partly attributable to

the poor distribution of space in school playgrounds or

sports facilities, as it does not take into account different

sporting preferences, to the prejudice of those children

who do not use material like football goal posts or

bas-ketball nets, who are generally girls [37, 39] Related to

these findings, we saw that boys also attended

extracur-ricular sport classes more frequently and for more hours

than girls (2.7 ± 1.6 days/week vs 1.8 ± 1.4 days/week;

p < 0.001 and 0.50 ± 0.36 h/day vs 0.38 ± 0.34 h/day; p =

0.001, respectively) (Table2) These kinds of differences

are similar to those observed in the ALADINO study

[30], where boys also spent more time in the practice of

extracurricular sport activities than girls

The mean time spent in sedentary leisure activities was 2.34 ± 1.08 h by girls and 2.48 ± 1.23 h by boys, being found significant differences between sexes only when time spent using PCs, tablets or game stations was ana-lyzed, being higher the time dedicated by boys to this kind of activity (p < 0.001) Other studies showed this higher time spent by boys in recreational use of com-puters or other electronic devices [40], even though girls usually spent more time in sedentary behaviors [41] Regarding sports preferences collected in Fig 2, the data showed that children tend to choose activities in line with their gender roles, with a higher female partici-pation in sports socially perceived as feminine, like dan-cing (94.1% girls vs 5.9% boys; p < 0.001) or rhythmic gymnastics (93.1% girls vs 6.9% boys; p < 0.001), while males participated more in sports socially perceived as masculine, like football (97.8% boys vs 2.2% girls; p < 0.001) or wrestling sports (85.7% boys vs 14.3% girls;

p < 0.001) [42, 43] Furthermore, girls also participated more than boys in skating (80% girls vs 20% boys; p = 0.005) and water sports (64.9% girls vs 35.1% boys; p =

Table 2 Differences in physical activity practice based on sex

Girls ( n = 179) Boys ( n = 181) Total ( n = 360) Physical activity and sedentary behavior indicators

Mean ± SD Median Mean ± SD Median Mean ± SD Median p

(1.39 –1.48) (1.41 –1.51) (1.40 –1.50)

(0.43 –0.94) (0.57 –1.14) (0.52 –1.07) Attendance at extracurricular sport classes (days/week) ( †) 1.8 ± 1.4 2.0 2.7 ± 1.6 3.0 2.3 ± 1.6 2.0 < 0.001

Time spent in extracurricular sport classes (h/day) ( †) 0.38 ± 0.34 0.29 0.50 ± 0.36 0.43 0.44 ± 0.35 0.36 0.001

(0.14 –0.57) (0.29 –0.71) (0.21 –0.64)

(0.71 –2.07) (1.00 –2.29) (0.91 –2.25) Use of PC/console/tablet (h/day) ( †) 0.76 ± 0.58 0.64 1.01 ± 0.78 0.86 0.88 ± 0.70 0.64 < 0.001

(0.50 –0.93) (0.57 –1.29) (0.50 –1.21)

(1.00 –2.00) (0.93 –1.86) (0.93 –2.00) Sedentary leisure (h/day) ( †) 2.34 ± 1.08 2.21 2.48 ± 1.23 1.64 1.78 ± 0.98 2.21 0.303

(1.71 –2.79) (1.21 –2.29) (1.64 –3.14) Adherence to recommendations

SD Standard deviation; IQR Interquartile range; PAL Physical activity level; MVPA Moderate to vigorous physical activity.

Significant differences according to sex (p < 0.05) are marked as bold.

†: p-value calculated by Mann–Whitney U-test.

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0.012), and boys enrolled more in handball (88.9% boys

vs 11.1% girls; p = 0.02) and racket sports (86.7% boys

vs 13.3% girls;p = 0.004), which is in line with the

litera-ture previously mentioned, where a greater tendency of

boys to practice team sports was reflected in contrast to

girls, who tended to practice individual ones [10,11,44]

These results are similar to those found in other studies

that analyzed children’s sports preferences [16, 45, 46]

and seem to remain true throughout life [47] Sports

segregation according to gender roles may be related to

the fear of being judged or bullied if gender norms are

not conformed to [37, 48] In fact, various articles have

shown that girls are more likely to engage in team sports when other girls are playing but not when boys are play-ing, because boys may exclude girls when they try to participate in sports in which girls are not socially con-sidered good enough [49–51]

Another relevant aspect of this research is the associ-ation between parental care and the practice of physical activity by the child shown in Table3 In relation to this, children are significantly at higher odds of engaging in physical activity when the father takes care of them (p = 0.008), an association not seen in mother care Neverthe-less, disparities have been found in the literature in this Fig 2 Sports preferences depending on sex * p < 0.05 ***p < 0.001 a) p-value represents differences among sexes

Table 3 Odds ratios and 95% confidence intervals for the practice of physical activity (PAL≥1.4) depending on the person in charge

of the child’s care

The father takes care of the child

( n = 185) NoYes 11.918 1.176–3.129 –0.009 11.873 1.140–3.078 –0.013 11.995 1.202–3.310 –0.008 The mother takes care of the child

( n = 332) NoYes 11.615 0.726–3.597 –0.240 11.637 0.725–3.700 –0.236 12.187 0.914–5.231 –0.079 Other person takes care of the child

( n = 89) NoYes 11.420 0.783–2.575 –0.249 11.718 0.929–3.176 –0.084 12.222 1.136–4.343 –0.020

Model 1: Not adjusted; Model 2: Adjusted by sex and age; Model 3: Adjusted by sex, age, and the other predictor variables Significant differences according to sex (p < 0.05) are marked as bold.

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respect For example, the results described by Rodrigues

et al [15], as well as those described by Fuemmeler et al

[52], showed that children were more likely to engage in

physical activity if both parents or the parent who shared

sex with them was active, whereas other studies revealed

results more similar to those found in our research,

showing a greater relationship between the physical

ac-tivity of the child and the influence of the father [53,54]

This fact reinforces the theory that physical activity is

culturally assumed as a masculine domain However, it

is also important to highlight the positive association

with physical activity practice by children when a person

different from their parents habitually takes care of them

(p = 0.020) Although this finding differs from the

previ-ous literature [55], it can be related to time disposal by

the person in charge of the care of the child, which is

exploited to spend time with the child accompanying

them to the park or in sports practice [56]

Strengths and limitations

The current study is one of the few to analyze the different

sports preferences and parental influence on children

phys-ical activity from a gender perspective However, there are

some limitations One of these limitations is the

cross-sectional design, which does not allow us to make causal

in-ferences on the observed associations As the study could

not be carried out in all the Autonomous Communities

needed, our sample is not a representative sample of the

Spanish population, so the results are not representative of

all the Spanish schoolchildren and they are not applicable to

other age groups Due to this low participation rate, the

sam-ple could be biased to some extent with families specially

in-terested in their children’s health, which can imply higher

physical activity rates than in general population Also, this is

a secondary analysis from the project“Sodium Sources and

Sodium Intake in a Representative Sample of Spanish

Chil-dren”, which was focused on evaluating the sodium intake of

Spanish schoolchildren through 24-h urine samples The

dif-ficulty in the collection of this measure has affected the

par-ticipation in the study, so the final sample was conformed to

the 20.15% of the contacted children Furthermore, we just

had the possibility to use questionnaires to collect physical

activity, instead of another more objective method as

acceler-ometer, which may lead to a bias towards underestimation

or overestimation of the physical activity practice by

school-children Therefore, the true associations could have been

stronger or weaker than the observed associations,

depend-ing on whether the misclassification was differential or

non-differential

Conclusions

The findings of this study indicated that girls practice

less physical activity and less intensely than boys,

engaging more in individual sports with artistic

connotations, while boys engage more in team sports or sports with a high physical contact component

On the other hand, when the father is in charge or takes care of the child, it is more probable that the child will be more physically active, independently of whether

or not the mother is also involved in his or her care Considering all the above, the creation of gender policies which take into account differences in sports preferences could foster the practice of physical activity by children, especially girls, who are actually less favored in this aspect However, other longitudinal or intervention studies should be carried out to analyze whether these differ-ences in sports practice between boys and girls can lead

to differences in the health status of children

Supplementary information

Supplementary information accompanies this paper at https://doi.org/10 1186/s12887-020-02229-z

Additional file 1 Socio-sanitary questionnaire Questionnaire used to obtain data on the children ’s caregivers, including the academic level of their parents and the household incomes.

Additional file 2 Daily physical activity questionnaire Questionnaire used to obtain data on children ’s physical activity, sedentary behavior and extracurricular sport classes.

Abbreviations BMI: Body mass index; CI: Confidence interval; IOM: Institute of Medicine; IQR: Interquartile range; MVPA: Moderate to vigorous physical activity; NAM: National Academy of Medicine; OR: Odds ratio; PAL: Physical activity level; SD: Standard deviation; VT: Vocational training; WHO: World Health Organization

Acknowledgments Authors would like to thank the children and parents who participated in the study, as well as the schools involved for their cooperation during the entire process of data collection.

Authors ’ contributions AP-S participated in research conduction and data collection, analysis and interpretation, as well as in original draft writing and formatting EC-S partici-pated in research conduction and data collection and analysis, as well as in the manuscript reviewing and editing JMP participated in research conduc-tion, data collection and original draft writing and reviewing BN participated

in research conduction, data collection and manuscript reviewing and edit-ing AML-S and RMO participated in research conceptualization and method-ology development, funding acquisition, project administration and provision of study materials, as well as in manuscript reviewing and editing All authors read and approved the final manuscript.

Funding This research was funded by Universidad Complutense de Madrid (UCM), through projects PR6/13 –18866, GR58/08, GR3/14, GR15/17 and UCM Research Group VALORNUT-920030 thorough FEI16/127.

Availability of data and materials The datasets generated and an alysed during the current study are not publicly available due to ethical restrictions and participant confidentiality but are available from the corresponding author on reasonable request Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee for Clinic Review

of the Clinic San Carlos Hospital, which is part of the Complutense University

of Madrid (Madrid, Spain) (Ref 12/319-E and 15/522-E) The participation in

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the study was voluntary and all the participants handed an informed

consent signed by their parents or guardians.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author details

1 Department of Nutrition and Food Science, Faculty of Pharmacy at

Universidad Complutense de Madrid, Madrid, Spain 2 Department of

Nutrition, Faculty of Health Science at Universidad Alfonso X El Sabio,

Villanueva de la Cañada, Madrid, Spain.3Research Group VALORNUT-UCM

(920030), Universidad Complutense de Madrid, Madrid, Spain.

Received: 3 March 2020 Accepted: 29 June 2020

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